Ladies, why you should be worried about your cervix...even though you'll probably never see it!

   For the past one month as part of my fourth year of medical training, I have been rotating in the
department of Obstetrics and gynaecology (basically the guys who specialise in pregnancy and other female problems). As we started going through the clinical areas, one thing became clear: Kenyan women don’t know as much as they should about something that could probably kill them. Wait, let me re-phrase that. Something that will definitely kill them if not caught early and dealt with...and it’s scary. So I’m going to give you a couple of facts to help you grasp the gravity of the situation. If you’re a guy and you’re reading this, you should forward this to any woman who is close to you...you might just save a life.

Now you know where your cervix is!

•  Generally speaking, cervical cancer is more prevalent than breast cancer among Kenyan women.  It mostly occurs in women aged 35-39 years and 60-64 years. We've  made such a brouhaha about breast cancer and substantially raised awareness about it. And that's a good thing. But most women are completely in the dark about this other important female cancer. 

•  Cervical cancer is sexually transmitted...in a manner of speaking. It’s caused by a virus called Human Papilloma Virus (HPV) which one can be infected with after sexual contact. In almost 100% of cervical cancer cases, HPV infection is present. Condoms DO NOT protect against HPV infection. Minor risk factors are smoking and HIV infection. In fact, HIV infection speeds - up the development of cervical cancer.

• There are many different strains of HPV. The high risk strains (mostly  HPV 16 AND 18) cause cervical cancer. The low-risk strains (mostly  HPV 6 and 11) cause genital warts. 

• Risk factors for HPV infection are mostly: Young age at first intercourse, multiple sexual partners, cigarette smoking, immuno-suppression.

•  It takes time to develop cervical cancer after HPV infection. There’s a latent period of about 20 years. Thankfully, the cancer takes a long time to develop, which means that with regular screening, it could be caught early and treated. And speaking of screening...

• Screening can be done by either a test called VIA/VILLI or a pap smear. VIA/VILLI  is done at most major health institutions in Kenya (including the former provincial hospitals), and will detect any abnormal pre-cancerous growths on the cervix that are visible to the naked eye. The downside is that it might not catch anything that is microscopic but  it still goes a long way towards helping us catch the disease early. A pap smear can be done at all hospitals  it actually allows us to detect abnormal cells microscopically even before they can be seen with the naked eye. Currently most pap smear samples have to be sent to Kenyatta national hospital to be analysed by Pathologists (because we don't have that many pathologists in the public sector), and as a result it takes a while for patients to receive their results. But at least it's something and hopefully this will change in the future.

•  How often should you get a pap smear? 3 years after your first sexual encounter,  then every 3 years if the smear is normal. 

• There is a vaccine against HPV and yes it is available in Kenya. It's  a 3-dose vaccine that you can get at any private  hospital for a total cost of Sh. 9,500. Or at Kenyatta National hospital at a total cost of Sh. 6,900. There are two types:

 Gardasil – Protects against HPV 6, 11 , 16 and 18.  

Cervarix – Protects against HPV 16 and 18   

(The vaccine offers life-long protection)

• Common symptoms of cervical cancer include: Abnormal vaginal bleeding ( Especially after sexual intercourse or in post-menopausal women), Foul smelling vaginal discharge, Weight loss.

• Treatment options:  As I've already said, treatment is very easy and available  in the early stages of the disease and will be guided by your doctor. The problem is that most women don't get screened and then end- up seeing a doctor when they've already developed advanced cancer.

   So i’m going to ask you to do something. I’m going to ask you to share this information with every
woman that you know because it’s disturbing when we see a patient describe the symptoms of stage 4 cervical cancer and there’s probably nothing we can do about it. Because it doesn’t make sense for
women (pillars of our community) to live in the dark about something this important. Because
Kenyan women’s lives matter! Don't be a statistic, get screened, get vaccinated, spread the word!

Ciao...

Teal ribbon - For cervical cancer awareness